Skip to Main Content
Skip Nav Destination

Clinical Diabetes Digital Publication

Rationale for the Use of Combination Injectable Therapy in Patients
With Type 2 Diabetes Who Have High A1C (≥9%) and/or Long Duration
(>8 Years)

Vivian A. Fonseca, MD, FRCP, Tulane University Health Sciences Center, New Orleans, LA
Minisha Sood, MD, FACE, Fifth Avenue Endocrinology, New York, NY
Rodolfo J. Galindo, MD, Emory University, Atlanta, GA

The recommended A1C targets for people with type 2 diabetes are between 6.5% and 8%. However, real-world data suggest that an increasing proportion of people with diabetes have suboptimal control, and approximately 15% have
A1C >9%. People with A1C >9% are at increased risk for micro- and macrovascular complications and require treatment intensification to improve glycemic control as early as possible.

In this short digital publication video series, Drs. Vivian Fonseca, Minisha Sood, and Rodolfo Galindo discuss the pathophysiological changes that occur during the progression of type 2 diabetes, with a particular focus on the key role of declining β-cell function, as well as the clinical characteristics—long duration of type 2 diabetes and A1C ≥9%—that are indicative of diminishing β-cell function. Drs. Fonseca, Sood, and Galindo also review the clinical data that support the use of available treatment options for these individuals, consistent with the current diabetes treatment guidelines, and specifically examine the role of fixed-ratio combination therapies of a basal insulin and a glucagon-like peptide-1 receptor agonist.

The videos can be viewed in their entirety below, and an executive summary of the panel’s recommendations is available on the Clinical Diabetes website at

This peer-reviewed publication was developed with adherence to Good Publication Practice (GPP3) guidelines. All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and have disclosed all potential conflicts of interest.


About the Authors

Vivian A. Fonseca, MD, FRCP, is Professor of Medicine, Assistant Dean for Clinical Research at the Tullis-Tulane Alumni Chair in Diabetes, and Chief of the Section of Endocrinology at Tulane University Medical Center in New Orleans, Louisiana.

Dr. Fonseca is Past President (2012) for Science and Medicine of the American Diabetes Association (ADA). He has also served on the Board of Directors for ADA and the American Association of Clinical Endocrinologists (AACE) and on the Board of Trustees of the American College of Endocrinology.

Dr. Fonseca has been Chairman of the Clinical Practice Committee of ADA, and he served on the ADA Disaster Task Force and ADA Strategic Planning Committee. He has held leadership roles and served on various committees in several other organizations, including the American Board of Internal Medicine, and has played a significant role in developing guidelines for treating diabetes (ADA and AACE), managing chronic disease and clinical trials after a natural disaster, and drawing attention to the global epidemic of diabetes, particularly in Asia.

ADA awarded Dr. Fonseca the Banting Medal for Leadership and Service, and the Southern Medical Association awarded him the Seale-Harris award. ADA presents the Vivian Fonseca Award annually for research on Diabetes in Asia. Dr. Fonseca has received several teaching awards and was elected to the Alpha Omega Alpha Honor Medical Society. He is a fellow of the Royal College of Physicians (London).

Back to the Top

Minisha Sood, MD, FACE, is a board-certified endocrinologist who is highly regarded by her peers and patients. Dr. Sood is Assistant Professor at the Hofstra School of Medicine and is in private practice (Fifth Avenue Endocrinology) in New York City. She is also a diplomate of the American Board of Obesity Medicine, and she holds a certification for endocrine neck ultrasound.

Dr. Sood received her medical degree from the Albert Einstein College of Medicine, and she completed her residency in Internal Medicine and a fellowship in Endocrinology, Diabetes and Metabolism at NYU Langone Medical Center. Dr. Sood is an active member of the American Association of Clinical Endocrinologists and the Endocrine Society and is a Board Member of the Independent Doctors of New York.

Back to the Top

Rodolfo J. Galindo, MD, is Assistant Professor of Medicine at Emory School of Medicine and serves as a principal investigator at the Center for Diabetes and Metabolism at Emory University Hospital Midtown. He is also Chair of the Hospital Diabetes Taskforce Group for Emory Healthcare. Dr. Galindo is Vice-Chair of the American Association of Clinical Endocrinologists (AACE) Diabetes State Committee and is a writing member for the AACE Guidelines for the Comprehensive Management of Diabetes. He has served as a member of the Diabetes Technology Society and is first author of the Consensus Guidelines Meeting for the Use of Diabetes Technology in the Hospital, published in 2020. Dr. Galindo is also President of the Georgia Society of Endocrinology.

Dr. Galindo’s research has been published in leading journals and he has received several awards, including the prestigious Leo M. Davidoff Award for Outstanding Teaching of Medical Students from the Albert Einstein College of Medicine and the FLARE – Future Leaders Advancing Research in Endocrinology award from the Endocrine Society.

Back to the Top


Vivian A. Fonseca, MD—Consulting/Lectures: Abbott, Asahi, AstraZeneca, Eli Lilly, Intarcia, Novo Nordisk, Sanofi-Aventis, and Takeda; Research Grants: Bayer, Boehringer Ingelheim, and Gilead; Stock Options: BRAVO4Health, Insulin Algorithms, and Microbiome Technologies; Stock: Amgen.

Minisha Sood, MD—Consultant/Advisory Boards: AstraZeneca, Mannkind, and Sanofi.

Rodolfo J. Galindo, MD—Consultant/Advisory Boards: Abbott, Eli Lilly, Novo Nordisk, Sanofi, and Valeritas; Research Grants: Dexcom and Novo Nordisk; Research Funding: National Institutes of Health.


This digital publication was funded by Sanofi US. The authors received writing and editorial support provided by Helen Jones, PhD, CMPP, of Evidence Scientific Solutions, funded by Sanofi US.

Back to the Top

Close Modal

or Create an Account

Close Modal
Close Modal